HomeMy WebLinkAbout13771 OLYMPIC AVE - Building Permits(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626
ELECTRICAL PERMIT
Job Address: 13771 OLYMPIC AV
Suite No
Vicinity:
Parcel Nunmber: 14153105
Applicant: MCKINISH, JERRY
Address:
Phone: 714-960-7052
Zip:
owner: , SUTHERLAND, ROBERT M TR
Address 13771 OLYMPIC AVE
Phone:
COSTA MESA, CA Zip: 92626
Contractor: JK CONSTRUCTION
Address: 915 LAKE ST
Phone: (714) 404-9846
HUNTINGTON BEACH, CA Zip: 92648
License: 450297
Status:
ISSUED
Applied:
02/22/2001
Issued:
02/22/2001
ISSUED BY:
SCOPE OF PERMIT
HCD REHABILITATION' PROGRAM. REF: B01-00233. MISC ELECTRICAL REPAIR IN GARAGE. "
INSTALL 3 RECEPTACLES & 1 LIGHT FIXTURE. - -
Quantity
ISSUE FEE
$23.50
-/0
Temp service test
$0.00
Temp Dist System / Lighting
Res. a/c package
$0.00
Busway /100 It
New Res (1-2 units)
$0.00
0
New Res (3+units)
$0.00
0
Pool / Spa
$0.00
0
Lighting Fixts
$1.10
1
Recept Outlets
$3.30
3
Switches
$0.00
-" 0'
Non Res Appl
$0.00
0
Res Appl
$0.00
:0
Service to 200a
$0.00
0 "
Service to 1000a
$0.00
0
Service over 1000a
$0.00
0
Motors to ihp
$0.00
0
Motors to 10hp
$0.00
0
Motors to 50hp
$0.00
- 0
Motors to 100hp
$0.00
0
Motors over 100hp
$0.00
0
Communication drops
$0.00
0
Sub panel to 200a
$0.00
0
Pole Light Pkg
$0.00
0
Sign Circuits
$0.00
0
Temp Pwr Pole
$0.00
0
Intermed Pole
$0.00
0
FEE SUMMARY,
$0.00'
-/0
Misc. Conduit
Quantity
Temp Dist System / Lighting
$0.00
0
Busway /100 It
$0.00
0.: '
Standing Section
$0.00
0 ,!;
Misc Electrical Equipment
$0.00
. 0;
Transformers up to 1 kva/kw
$0.00
- $0.00
................ up to 10 kva/kw
$0.00 - /',
0
.................up to 50 kva/kw
$0.00
0 "
................. up to 100 kva/kw_
$0.00/,/
0 .-
............ ..... over 100 kva/kw
.$0.00
0 - -
Low Voltage Equipment
"$0.00
0
Low Volt Wiring System / Ckt-
$0.00'
-/0
Misc. Conduit
$0.00
, ; 0
Misc. Conductor -
$0.00
0
Circus ( gen or ride)
$0.00'
- 0, ,
Circus (mech ride or lights)
. $0:00 ,
0
Christmas Tree Stand
$0.00
' 0
Fireworks Stand
- $0.00
' 0
Other Electrical Fee -
$0.00
Investigation Fee $0.00
Plan Check Fee $0.00
Reinspection Fee $0.00
TOTAL CALCULATED FEES $27.90
COMMENTS / SPECIAL CONDITIONS
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations. (Ord. No. 92-28, § 1, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714) 754.5626
2"646 (6100)
WORKERS' COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations:
❑ 1 have and will maintain a certificate of consent to self -Insure for workers' compensation, as provided for by section 3700 Of the Labor Code, for the performance of the
� /� work for which this permit is issued.
L],(.) Ihalve and will maintain workers' compensation Insuranc required by section 3700 of the Labor Code, for the performance of the work for which this permit is issued.
l/" My workers' co aI� tioo�`'.,ran�� cEfier and po number are: /�
Carder,^ 4r�Yr-� %L y s Policy,Numbei. G 6 a�
(This section neer'-not be completed i/ the permit 1s vatuadat one hundred dollars ($100) or less.)
❑ 1 certify that 1 e performance of th work r this permit is issued, I shall not employ any person in any manner so as to become subject to the workers'
campers on Is of California, a agrI should become subject to the workers' compensation provisions of Section 3700 of the bor Code, 1 shell forthwith
comply these revisions
-Applicant Signature: Date:_ -� g
WARNING:' FAILU SECU W ERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBIECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND (5100, ),I ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that Lam licensed under rovisions of pier 9 commencing with Section 7000) of Division of the Business a Professions Code, and my license is in full
force and eeectf�c.4 �' �--Class'N� f
Contractors Signature. Date:--' i�--
I
CONSTRUCTI DIN ENCY:
❑ 1 hereby inn that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code).
Lenders Name: Lender's Address:
Signature: Date:
OWNER -BUILDER DECLARATIONS:
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Professions
Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit
to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the
Business and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars ($500),):
❑ 1, as owner of the property, or my employees with wages as their sole compensation, WILL DO THE WORK, and the structure is not intended or offered for sale (Sec.
7044, Business and Professions Cede: The Contractors License Law does not apply to an owner of property who builds or improves thereon, and who does such work
himself or herself or through his or her own employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is
sold within one year of completion, the owner -builder will have the burden of proving that he or she did not build or improve for purpose of sale.).
❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions
Code: The contractors License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such project with a contractor(s)
license pursuant to the Contractors License Laws.).
❑ 1 am exempt under sec. Business and Professions Code for this reason:
Signature: Date:
Owner ID verified by driver's license. ❑ Yes ❑ No Drivers License No. Expires:
Verification of Ownership by (type of document, i.e. - property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify that no excavation five (5) or more feet in depth into which a person is required to descend, will be made in connection with work authorized by this
permit, and that no building structure, scaffolding, falsework, or demolition or dismantling thereof, will be more than thirty-six (36) teat high. (Chap. 3.2, Grp 2, Art 2, Sec.
341, Title B, California Administrative Cede).
❑ As owner -builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has a
permit to do such work from the division.
Signature: Date:
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? ❑ Yes ❑ No
(Section 25505 of the California Health and Safety Code requires, with some exceptions. that a Business Plan be filed with the Costa Mesa Fire Department by every
business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons,
or 200 cubic feet of compressed gas at standard temperature and pressure).
.............................. .... .... ............................ .. ...........................................................................................................................................................
.....................
2 Does or will the applicant or present or future building occupant need to file a registration forth for acutely hazardous materials? ❑ Yes ❑ No
(Section 25533 of the California Health and Safety Code, with some exceptions, requires registration with the Costa Mesa Fire Department by each business which at any
one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of
compressed gas at standard temperature and pressure).
.................................................... ......_............................................................ ..................................... ................................. ................................................................ ......................... .......................................... ...........................................................
3 Does or will the applicant or present or future building occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)?
❑ Yes ❑ No
(Section 25534 of the Califomia Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation, certification and filing with the Fire
Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department.
.._.................. .......................... .... _............. _.............. _... .... ......._-.......................................... ___......... _..... _.__........... -........ -............. -................................. ........................ ............. ......................................... ................... I..............................
4 If an RMPP is presently required, has Section 25534 of the Califomia Health and Safety Code been fully complied with? ❑ Yes ❑ No
.....................-......................................... ............... .......... .... .................................................,.................................................................................................................... ... ................ ..........-................... .,.......... ......................................................
....
5 Does or will the applicant or present or future building occupant require for the work which is the subject of this implication apermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? LI Yes U No
(Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits).
.........................................................................................-..........................................................................,,..........,.....,...,................,..............................................................................................................,...................................................I............
6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑ Yes ❑ No
(It yes", the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code).
.................._.................._....................................._._.............._................................... ............... ................ ,............................................ ...................................................... _......... ..........................
7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this
application, have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑ Yes ❑ No
................................................................... ..........-............ ................................................................... ........... -....................................................... ........................................ .................................................. -............. ............ ... .................................
.
e (If yes", attach cartificate of compliance from the appropriate air pollution control officer).
CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances
regarding Hazardous Materials and Emissions.
Signature: Date:
CERTIFICATE OF COMPLIANCE ANDA ORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is
Correct. I agree to comply with all slet�t s and city ordinances relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the
above-described property for inspe i6 urposes. I e t to occupy or allow occupancy of any building authorized by this permit until final inspection.
Si re 0 e Date
O /•
AnYHO umorized Applicant—s
CODE 1, INSP106TYP INTITALSi CiODE# INSPECTION TYPE ga¢, INTITIALS
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing
200 Final Re -Roof 210 Final Electrical
201 Final Block/Retaining Wall 212 Final Fire Prevention
202 Final Factory Fire Place 220 Final Planning Approval
203 Final Sign 222 Final Site
204 Final Demolition 250 Final Building/Occupancy
(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626
Job Address: 13771 OLYMPIC AV
Suite No
Vicinity: '
Parcel Number: 14153105
Applicant: MCKINISH, JERRY
Address:
MECHANICAL PERMIT
Phone: 714-960-7052
Zip:
ISSUED BY:
Status: ISSUED
Applied: 02/22/2001
Issued: 02/22/2001
COMMENTS / SPECIAL CONDITIONS
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations. (Ord. No. 92-28, § 1, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned
for a period of 180 days. rte%
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes,.and all
required inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714) 754-5626
244646 (6100)
Owner:
.SUTHERLAND, ROBERT
M TR
Address:
13771 OLYMPIC AVE'
,
Phone:
COSTA MESA, CA
Zip:
92626
Contractor:
JK CONSTRUCTION
Address:
915 LAKE ST
-
Phone:
(714)404-9846 -
HUNTINGTON BEACH,
CA
Zip:
92648
"
License:
450297
"
Arch / Eng
Address:
--
Phone:-
.
Zip:
-
-
License:
'
SCOPE OF PERMIT
HCD REHABILITATION.PROGRAM.
REF: B01-00233. FURNACE CHANGE OUT. INSTALL VENT
"-
FAN IN BATHROOM.
-
-
FEE SUMMARY
Quantity
Quantity
ISSUE FEE
$23.50
Repair/ Alt Absorbtion Unit
$0.00.
0
Inst FAU <100 k BTU
$14.80
1
Repair,/ Alt Refrigeration Unit -
$0.00
0
Inst FAU >100 k BTU
$0.00
0
Ventillation System
$0.00
0
Repair/ Alt Cooling/Heat $0.00
0 -
Evaporative.Cooler_;. �:-
$0.00"
0
Inst / Rep. Recess Wall
Htr $0.00 '--0
-,
Commercial Incinerator
$0.00
` 0
Refrig Sys <100 k BTU
$0.00
0
Domestic Incinerator , _
$0.0011
0
Refrig Sys >100 k BTU
$0.00 '10
,
Compressors /Absorption Systems,
Gas Piping
$0.00
0
Up to 3 hp / 100 k BTU.
; $0:00
0
Factory Fireplace
$0.00
0 -
3 To 15 hp / 500 k BTU
,-$0.00
0
Hood w/Mech Exhaust
$0.00
0
15 To 30 hp / 1,000 k BTU, -
$0.00
0
VAV Box
$0.00
0
30 To 50 hp / 1,750 k BTU . ".
$0.00
0
Vent Fan / Single Duct
$7.25
1
Over 50 hp / Over 1,750 BTU
$0.00
0
Appliance
$0.00
0
Boilers
Fire Dampers
$0.00
0
Up to 3 hp
$0.00
0
Smoke Dampers
$0.00
0
3 To 15 hp
$0.00
0
Inst or Relocate Appl Vent $0.00
0
15 to 30 hp
$0.00
0
Air Handlers < 10000cfm $0.00
0
30 to 50 hp
$0.00
0
Air Handlers > 10000cfm $0.00
0
Over 50 hp
$0.00
0
Floor Furnace
$0.00
0
Other Mechanical Fee
Floor or Suspend Heater
$0.00
0
Investigation Fee
$0.00
Plan Check Fee
$0.00
Reinspection Fee
$0.00
TOTAL CALCULATED FEES
$45.55
COMMENTS / SPECIAL CONDITIONS
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations. (Ord. No. 92-28, § 1, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned
for a period of 180 days. rte%
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes,.and all
required inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714) 754-5626
244646 (6100)
DECLARATIONS
WORKERS' COMPENSATION DECLARATION:
I hereby affiml under penalty of perjury one of the following declarations:
❑ I have and will maintain a certificate of consent to self -Insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the performance of the
work for which this permit is issued.
'I,have and will maintain workers' compensation insurance, as required by section 3700 of the Labor Cade, for the performance of the work for which this Permit is issued.
�My workers' wmoe anon Insur ce carder and policy number are: /
_Carder.— Po0'cy Number: - G1
_ (This section need not be wmpletetl it permit valued at one hundred dollars ($100) or less.)
❑ 1 certify that in e p Orman the w r Ich this permit is issued, I shall not employ any person in any manner so as to become subject to the workers'
compensatio laws o Calif ni and t if I should become subject to the workers' compensation provisions of Section 3700 of the La Code, I shall forthwith
comply with t se pr 'si s. .� /
'WARNING
Signature: Date: �1 G�
WARNING: FAILURET_ _ RKE ' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALT 5 AND 61VIL FINES UP TO ONE HUNDRED
THOUSAND DOL -A, ( ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES,
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am licensed under pr visions of Chapter 9 (co ncing with Section 7000) of Division 3 of -the Business and Professions Code, and my license is in full
force and effect. u - ' 7 class a_J
Contractors Signature: ,Date:
14
CONSTRUCTION L DING =:
❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code).
Lenders Name: Lenders Address:
Signature: Date:
OWNER -BUILDER DECLARATIONS:
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Professions
Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its Issuance, also requires the applicant for such permit
to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law (Chapter 9 (commencing with Section 7000) o1 Division 3 of the
Business and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant fora permit
subjects the applicant to a civil penalty of not more than five hundred dollars ($500).):
❑ I, as owner of the property, or my employees with wages as their sole compensation, WILL DO THE WORK, and the structure is not intended or offered for sale (Sec.
7044, Business and Professions Code: The Contractors License Law does not apply to an owner of property who builds or improves thereon, and who does such work
himself or herself or through his or her Own employees, provided that such improvements are not intended or offered for sale. It, however, the building or improvement is
sold within one year of completion, the owner -builder will have the burden of proving that he or she did not build or improve for purpose of sale.).
❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions
Code: The contractors License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such project with a contractor(s)
license pursuant to the Contractors License Laws.).
❑ I am exempt under sec. Business and Professions Code for this reason:
Signature: Date:
Owner ID verified by drivers license. ❑ Yes ❑ No Drivers License No. Expires:
Verification of Ownership by (type of document, i.e. - property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify that no excavation five (5) or more feet in depth into which a person is required to descend, will be made in connection with work authorized by this
permit, and that no building structure, scaffolding, falsework, or demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 3.2, Grp 2, Art2, Sec.
341, Title 8, Califomia Administrative Code).
❑ As owner -builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has a
permit to do such work from the division.
Signature: Date:
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? ❑ Yes ❑ No
(Section 25505 of the California Health and Safety Code requires, with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every
business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds, or a volume Of 55 gallons,
or 200 cubic feet of compressed gas at standard temperature and pressure).
.....................................................................................I ................ _...... ............................... _..............................................................................................................................................................................................................
2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑ Yes ❑ No
(Section 25533 of the California Health and Safety Code, with some exceptions, requires registration with the Costa Mesa Fire Department by each business which at any
one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet Of
compressed gas at standard temperature and pressure).
.................... _..............._.........._........... _..........................._.............................................................................................................................................................................................................................................................................................
3 Does or will the applicant or present or future building occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)?
❑ Yes ❑ No
(Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation, certification and filing with the Fire
Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department.
.................................................................r'e-..............................................................................................................................................................................jpIi.................................................................................................................................
4 If en RMPP is presently required, has Section 25534 0l the California Health and Safety Code been fully complied with? ❑ Ves ❑ No
5 Does or will the applicant orpresent or future building occupant require for the work which is the Subject this LJ Yes ion apertnit for such construction or modification
from the South Coast Air Quality management Distract or from any other air pollution control distract or agency?
] y? LYes LJ No
(Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits).
........................................................................................................................................................................................................................................................................................ .......................................................................................
e Will any part of the facility to be constructed under this permit be within 1000 feat from the outer boundaries of a school? El Yes ❑ No
(if -yes-, the facility must meet the requirement of Sections 25534 and 42303 Of the California Health and Safety Code).
......................_........... _..........-........................................................................._...__._._.._._.....................................................................___.............................................................................
7 If a permit from the South Coast Air Quality Management District or other air pollution Control district Or agency is required for the work which is the subject of this
application, have all of the disclosures prescribed by California Health and Safety Coda Section 42303 been made? ❑ Yes ❑ No
...........................................................................................................................................................................................................................................................................................................................................................................................
6 (II'yes", attach certificate of compliance from the appropriate air pollution control officer).
CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances
regarding Hazardous Materials and Emissions.
Signature: Date:
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is
correct. I agree to comply with all slate law and city, nance elating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the
above-described property for inspection frposes. gra ccupy or allow occupancy of any building authorized by this permit until final inspection.
r ---------- O e s) � date /
An Or AdIlhorized Applicant I Date ---_ 1
PAIS INTITALS CODEC INSPECTION TYPE IMM
1616 Fixed System Final Fire Prevention 206 Final Mechanical • I H _ o l� W
1266 Pool Spa Final 208 Final Plumbing
200 Final Re -Roof 210 Final Electrical
201 Final Block/Retaining Wall 212 Final Fire Prevention
202 Final Factory Fire Place 220 Final Planning Approval
203 Final Sign 222 Final Site
204 Final Demolition 250 Final Building/Occupancy
(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa. ILDING PERMIT 77 FAIR DRIVE, COSTA MESA, CA 92626
Job Address: 13771 OLYMPIC AV
Suite:
Vicinity:
Parcel Number: 14153105
Applicant: MCKINISH, JERRY
Address:
Owner: SUTHERLAND, ROBERT M TR
Address 13771 OLYMPIC AVE
COSTA MESA, CA
Contractor: JK CONSTRUCTION
Address: 915 LAKE ST
HUNTINGTON BEACH, CA
Zip: 92648
Arch
Address:
Zoning:
Phone: 714-960-7052
Zip:
Phone:
Zip: 92626
Phone: (714)404-9846
License: 450297
Eng:
Address:
Status: ISSUED
Applied: 02/22/2001
Issued: 02/22/2001
ISSUED BY:
b
- Phone: Phone:
Zip: License: License:
SCOPE OF PERMIT
HCD REHABILITATION PROGRAM. REMOVE EXISITING ROOF AND RE -ROOF WITH.30 YEAR COMP. REPLACE, 10 RAFTER
TAILS, REPLACE SHEATHING AS REQUIRED. OTHER WORK TO BE COMPLETED: INSTALL SOLID CORE DOOR LEADING
TO GARAGE, REMOVE WINDOWS IN LIVING ROOM AND KITCHEN AND INSTALL NEW DUAL GLAZED WINDOW IN LIVING
ROOM AND A GREEN HOUSE WINDOW IN THE KITCHEN. -
NOTES:
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations. (Ord. No. 92-28, § 1, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714) 754-5626
2446-46(6/00)
FEE SUMMARY
I,
Plan Check:
$0.00
Calc Valuation: x $15,500.00
Permit:
$279.25
Claim Valuation:'". $16,500.00
SMIP Res:
$1.65
SMIP Com:
$0.00'
Other:
$0.00
Inspection:
$0.00
Total:
$280.90
-
PLANNING & ZONING
SETBACKS
MAIN STRUCTURE Front 0-0
Rear 0-0 Left 0-0
Right 0-0
ACCESSORY
Front 0- 0 -
Rear 0-0 Left 0-0
Right "_ 0-0
PARKING
Existing: 0
Required: 0 Proposed: - 0
NOTES:
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations. (Ord. No. 92-28, § 1, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714) 754-5626
2446-46(6/00)
DECLARArIONS
WORKERS' COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations:
❑ I have and will maintain a certificate of consent to self-Insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the performance of the
work for which thks permit is issued.
I have and will maintain workers' compensation insypoInce, as required by section 3700 of the Labor Cade, for the performance of the work for which this permit is issued.
—My workers' co noion.lnsuran der an olicy number are: t/ -
Camer-.- r 7aZ � Policy Number,�—
`(This`section need not be comp efed i/ th emit is valued at one hundred dollars ($100) or lass.)
❑ 1 certify that in the performance a work r which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers'
compensatio of Califom' , nd agr at hould become subject to the workers' compensation provisions of Section 370
7 f the r Code, I shall forthwith
comply with t ase revisions
-- - L G
�pacant Signature: (---Dele:-"
WARNING: FAILURE T CURE ERS' PENSATION COVERAGE IS UNLAWFUL AND SHALL SUMECT AN EMPLOYER TO CRIMINAL NA' TIES D CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLA 00,000), ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 37M OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I-am licanseo under provisions of apter 9mg with Section 7000) of Division 3 of the Business and Protessions Code, and my license Is in full
force and effect iLic.1. 503-9 Class
Contractors Signature:_ - Date:-
��- Z 6 i
CONSTRUCTION LEN6W6 AGENCY:
❑ 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code),
Lender's Name: Lender's Address:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Professions
Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit
to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law (Chapter 9 (commencing With Section 7000) of Division 3 of the
Business and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars ($500).):
❑ I, as owner of the property, or my employees with wages as their sole compensation, WILL DO THE WORK, and the structure is not intended or offered for sale (Sec.
7044, Business and Professions Code: The Contractors License Law does not apply to an owner of property who builds or improves thereon, and who does such work
himself or herself or through his or her own employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement Is
sold within one year of completion, the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.).
❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions
Code: The contractors License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such project with a contractor(s)
license pursuant to the Contractors License Laws.).
❑ 1 am exempt under sec. Business and Professions Code for this reason:
Signature: Date:
Owner ID verified by drivers license. ❑ Yes ❑ No Driver's License No. Expires:
Verification of Ownership by (type of document, i.e. - property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify that no excavation five (5) or more feet in depth into which a person is required to descend, will be made in connection with work authorized by this
permit, and that no building structure, scaffolding, falsework, or demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec.
341, Title 8, California Administrative Code).
❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has a
permit to do such work from the division.
Signature: Date:
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
I Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? ❑ Yes ❑ No
(Section 25505 of the California Health and Safety Code requires, with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every
business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons,
or 200 cubic feet of compressed gas at standard temperature and pressure).
......._....................................................._...................-.... ............................................................ _................................................................................... ......................................................... ....................... .................................................................
2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑ Yes ❑ No
(Section 25533 of the California Health and Safety Code, with some exceptions, requires registration with the Costa Mesa Fire Department by each business which at any
one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of
compressed gas at standard temperature and pressure).
............................................................................................................................................................................................................................................................................................................................................................................................
3 Does or will the applicant or present or future building occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)?
❑ Yes ❑ No
(Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation, certification and filing with the Fire
Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department.
4 If an RMPP is Dresenily required, has Section 25534 of the California Health and Safety Code been fully complietl with? ❑Yes ❑ No
........................................t.h.o....................................................................... ildi............................................................................................................................................................................................................................................difi...............
5 Does or will the applicant or present or future building occupant require for the work which is the subject c this a plication a ermil for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control distract or agency? � Vas � No
(Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits).
........................... ..................... ..................... ......................... ......................................-..................................................................................... ..................................I....................... ................................................................................................
6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes ❑ No
(if 'yes', the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code).
.......................................................................................... ............................................................................................................................ .................................................................................................. ................. .................................. ................
7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this
application, have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑ Yes ❑ No
............................................... _........ _...................... _.............. _............................................................... -..................................................................................................... ...................... _............. ..... ....................... ............................... _..............
B (If 'yes", attach certificate of compliance from the appropriate air pollution control officer).
CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances
regarding Hazardous Materials and Emissions.
Signature: Date:
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is
correct. I agree to comply with all state laws an city ordinances relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the
above-describer) property for inspection pure s. I agree t to cupy or allow occupancy of any building authorized by this permit until final inspection.
Sign r e r p to
zed Applicant— — 7 Date"- -.`
CODE I, INSPECTION TYPE PATE INrruLS CODE INSPECTION TYPE g 1NTITALfi
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing
200 Final Re-Root 210 Final Electrical
201 Final BlocWRelaining Wall 212 Final Fire Prevention
202 Final Factory Fire Place 220 Final Planning Approval
203 Final Sign 222 Final Site . !
204 Final Demolition 250 Final Building/Occupancy
(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us •77 FAIR DRIVE, COSTA MESA, CA 92626
PLUMBING PERMIT
Job Address:
Suite No
Vicinity:
Parcel Nunmber:
13771 OLYMPIC AV
14153105
Applicant: MCKINISH, JERRY
Address:
Owner: SUTHERLAND, ROBERT M TR
Address 13771 OLYMPIC AVE
COSTA MESA, CA
Contractor: JK CONSTRUCTION
Address: 915 LAKE ST -
Arch / Eng :
Address:
HUNTINGTON BEACH, CA
Phone: 714-960-7052
Zip:
Phone:
Zip: 92626
Phone: (714)404-9846
Zip: 92648
License: 450297
Phone:
Zip:
License:
ISSUED BY:
Status: -ISSUED
Applied: 02/22/2001
Issued: 02/22/2001
S AIT -
HCD REHABILITATION PROGRAM. R 01-00233. RE CE WATER HEATER, REMOVE EXISITNG
SHOWER AND REPLACE WITH WHEEL CHAJR7V5eEtMLE SHOWER. - -
COMMENTS / SPECIAL CONDITIONS
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations. (Ord. No. 92-28, § 1, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable c d ,and all
required inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714) 754.5626
244646 (6/00)
FEE SUMMARY
AMT -
QTY--
AMT
QTY'-'-,
-
,AMT
QTY
ISSUE FEE
$23.50
Laundry Tub / Washer
$0.00
0
Sump Pump
% $0.00
0
Backflow irrigation
$0.00
0
Landscape Irrigation
$0.00
0
Swimming Pool - /
$0.00
0
Backflow Preventer
.$0.00
0 -
- P -Trap
$0.00
0 -
Trap Primer ,
$0.00
0
Bathtub
$0.00 -'
0
Pressure Regulator
$0.00
0 -"
Urinal, ,
$0.00
0
Clarifier System -
$0.00
0
Process Piping (per 10 ft)
$0.00
0
Vacuum Brkr Bkflow(1-4)
$0.00
0
Connect (Ice,Soda,etc)
$0.00
0
Receptors
$0.00
0
Vacuum Brkr Bkflow(5+)
$0.00
0
Dental Units
$0.00
0
Septic Tank
$0.00
0
Wash Basin
$0.00
0
Dishwasher
$0.00
0
Sewer Cap for Demo
$0.00
0
Wash Basin Set
$0.00
0
Drain, Floor
$0.00
0
Sewer Connect
$0.00
0
Waste and Vent System
$0.00
0
Drain, Rainwater
$0.00
0
Sewer Private Line
$0.00
0
Water Closet (Toilet)
$0.00
0
Drain, Roof
$0.00
0
Shower
$9.80
1
- Water Heater / vent
$12.30
1
Drinking Fountain
$0.00
0
Sink, bar
$0.00
_
0
Water Piping (Inst or Rep.)
$9.80
1
Expansion Tank
$0.00
0
Sink, commercial
$0.00
0
Water Re -pipe
$0.00
0
Gas Earthquake Valve
$0.00
0
Sink, Floor
$0.00
0
Water Service
$0.00
0
Gas 111-4 outlets)
$0.00
0
Sink, kitchen
$0.00
0
Water Softener
$0.00
0
Gas (Over 4 outlets)
$0.00
0
Sink, service/mop
$0.00
0
OTHER
$0.00
Gas Repipe
$0.00
0
Spa (private)
$0.00
0
VIOLATION
$0.00
Gas Service
$0.00
0
Spa (public)
$0.00
0
PLAN CHECK
$0.00
Interceptors (Grease, Oil)
$0.00
0
REINSPECTION
$0.00
0
Interceptors (Sand Auto )
$0.00
0
TOTAL CALCULATED FEES:
$55.40
COMMENTS / SPECIAL CONDITIONS
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations. (Ord. No. 92-28, § 1, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable c d ,and all
required inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714) 754.5626
244646 (6/00)
DECLARATIONS
WORKERS' ffl WOW DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations:
❑ I have and will maintain a certificate of consent to self-Insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the performance of the
work for which this permit is issued.
I have and will maintain workers' compensation insurance, as required by section 3700 of the Labor Code, for the performance of the work for which this permit is issued.
rMy workers'compensation Insurance carrier end policy number are:
Carder: - -1 J / g �i FUS 0 Policy Number:
(This section need not be completed if the permit is valued at one hundred dollars ($100) or less.) '—�-'—
❑ 1 certify that in the performance the worVfor which this pernit is issued, I shall not employ any person in any manner so as to become subject to the workers'
compensation i Califon and agr f I should become subject to the workers' compensation provisions of Section 3700 of th Labor Code, I shall forthwith
comply with I se pr isio -
Applicant Signature: Date:-==s 2 2
WARNING: FAILURE T ORKERS' PENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PE TIES AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLAR IS I ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEYS FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I.am{licensed u d r rovisions i Chapter 9 (commencing with Section 7000) of Division 3 of-the Business an rofessions Code, and my license is in full
force and effect. Lic. 4 " J"Q Class 4 J
Conlractors.Signature: Date: 2-
CONSTRUCTION
CONSTRUCTION N G ENCY:
❑ 1 hereby atfirrfr<at there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code).
Lenders Name: Lenders Address:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Professlons
Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit
to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the
Business and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars (S500).):
❑ I, as owner of the property, or my employees with wages as their sole compensation, WILL DO THE WORK, and the structure is not intended or offered for sale (Sec.
7044, Business and Professions Code: The Contractors License Law does not apply to an owner of property who builds or improves thereon, and who does such work
himself or herself or through his or her own employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is
sold within one year of completion, the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.).
❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions
Code: The contractors License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such project with a contractor(s)
license pursuant to the Contractors License Laws.).
❑ 1 am exempt under sec. Business and Professions Code for this reason:
Signature: Date:
Owner ID verified by drivers license. ❑ Yes ❑ No Drivers License No. Expires:
Verification of Ownership by (type of document, i.e. - property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ 1 hereby certify that no excavation five (5) or more feet in depth into which a person is required to descend, will be made in connection with work authorized by this
permit, and that no building structure, scaffolding, falsework, or demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 3.2, Grp 2, Art2, Sec.
341, Title 8, California Administrative Cade).
❑ As owner-builder, I will not employ anyone to do Work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has a
permit to do such work from the division.
Signature: Date:
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1 Will the applicant or present or future building Occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? ❑ Yes ❑ NO
(Section 25505 of the California Health and Safety Code requires, with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every
businosf which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons,
or 200 cubic feet of compressed gas at standard temperature and pressure).
........ _.............. _............._................................................ ..... .............. ............................................................ I...._.............................. ........................................................................ ........................................ ....
2 Does or will thea applicant or resent or future building Occupant need to file a registration form for acute) hazardous materials?
PP P 9 P 9 Y ❑Yes ❑ No
(Section 25533 of the Califomia Health and Safety Code, with some exceptions, requires registration with the Costa Mesa Fire Department by each business which at any
one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of
compressed gas at standard temperature and pressure).
........................ ..._........................... _...................................................................................................................................................................................................................................... ....................... _...................................................... .............
3 Does or will theappplicant or present or future building occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)?
❑ Yes ❑ No
(Section 25534 of the California Health and Safety Cade provides that the Costa Mesa Fire Department may require the preparation, certification and filing with the Fire
apartment of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department.
....................................................................................................................................................................................................................................................................._................ ............................................................................................
4 If an RMPP is presently required, has Section 25534 of the California Health and Safety Code been fully complied with? ❑Yes ❑ No
5 Does or will the applicant or present or future building occupant require for the work which is the subject this a plication aQQermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes L_I No
(Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits).
............................... ....................._........................._........_.......__.................................. ................................................................................................ ........................................... ....................................................................................................
6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑ Yes ❑ No
(if 'yes", the facility must meet the requirement of Sections 25534 and 42303 of the Califomia Health and Safety Code).
............................................................................................................................................................................................................................................................................................................................................................................................
7 If a permit from the South Coast Air Quality Management Dishict or other air pollution control district or agency is required for the work which Is the subject of this
application, have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑ Yes ❑ No
..............................................................................................._.............................................................................................................................................. ................................................................................................................................ _...........
B (If'yes", attach certificate of compliance from the appropriate air pollution control officer).
CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances
regarding Hazardous Materials and Emissions.
Signature: Date:
CERTIFICATE OF COMPLIANCE AND A IZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is
correct. I agree to comply with all state nd city ordinances relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the
abo - scribed props rt for ins 1 agree not to Occupy of allow Occupancy of any building authorized by this permit until final Inspection.
f9igrature Of L gal Owner(s) at/L LIZ
And/or'Authorized-Applicant (_q6te
CODE 1. INSPECTIONTYPE 2A3 INTMIALS CODE INSPECTION TYPE PAR INTITIALS
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing
200 Final Re-Roof 210 Final Electrical
201 Final Block/Retaining Wall 212 Final Fire Prevention
202 Final Factory Fire Place 220 Final Planning Approval
203 Final Sign 222 Final Site
204 Final Demolition 250 Final Building/Occupancy